The bioethical experiences of student dietitians on their final clinical placement

Abstract

Dietetic students are exposed to bioethical dilemmas on clinical placements; however, the nature of these situations has not been investigated. The present study aimed to analyse students' reports of incidents and their associated personal development plans (PDP) to assess the type of ethical incidents faced and how they cope with them. Final-year dietetic students were recruited via an announcement in class. The students' PDPs were analysed using thematic analysis to identify the type of ethical issues faced and how they felt about them. The 500-word PDPs were submitted after the final placement. Thirteen (13/26) students identified 'ethics' as a learning need and most of these incidents were related to enteral feeding (10/13). Ethical issues identified related to nonmaleficence; best interest; consent and capacity; truth telling and integrity; autonomy and substituted decision-making; futile treatment; beneficence and confidentially. The themes for how the students coped included being unsure; lack of confidence or knowledge with ethics and/or with communication; lack of experience; unease/concern about shared decision-making; and their own role in the situation. Student dietitians are exposed to a wide range of complex ethical clinical situations, with those related to enteral feeding being the most common. Students felt unsure of what to do and lacked confidence, which resulted in unease and concern; however, students appeared to have some ethical sensitivity. Communication problems with the multidisciplinary team or families were a common theme. Clinical educators need to support students in these situations and act as role models.